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Vsd 001 Sample
State of California
Veteran Status and
SECTION 1 - TO BE COMPLETED BY THE APPLICANT REQUESTING VETERAN STATUS AND/OR SERVICE CONNECTED DISABLITY VERIFICATION PRINT USING BLUE OR BLACK INK 
FIRST NAME
MIDDLE NAME
LAST NAME
SUFFIX
DRIVER LICENSE OR IDENTIFICATION NUMBER
STATE OF ISSUANCE
DATE OF BIRTH (MM/DD/YYYY)
EMAIL ADDRESS
DAYTIME TELEPHONE NUMBER
MAILING ADDRESS
CITY
STATE
ZIP CODE
RESIDENCE ADDRESS IF DIFFERENT FROM MAILING ADDRESS ABOVE
CITY
STATE
ZIP CODE
SECTION 2 - APPLICANT CERTIFICATION
I certify (or declare) under penalty of perjury under the laws of the State of California, that I have served in the United States uniformed services and received an other than dishonorable discharge, or served in a Guard or Reserve component and was mobilized for federal active duty. The information I provided is true and correct. I authorize County Veterans Service Office (CVSO) employees, officers, and designees to verify the documents presented.
APPLICANT SIGNATURE
_
DATE
SECTION 3 - TO BE COMPLETED BY AUTHORIZED COUNTY VETERANS SERVICE OFFICE EMPLOYEE, OFFICER, OR DESIGNEE
COUNTY VETERANS SERVICE OFFICE ADDRESS
CITY
STATE
ZIP CODE
PHONE NUMBER
COUNTY
EMAIL ADDRESS
As a representative of the County Veterans Service Office of the above named county, and designee of the California Department of Veterans Affairs, I certify under penalty of perjury under the laws of the State of California, that I have reviewed the documentation required and that the above named individual meets the qualifications noted above.
COUNTY VETERANS SERVICE OFFICE REPRESENTATIVE'S SIGNATURE
DATE
COUNTY VETERANS SERVICE OFFICE REPRESENTATIVE'S PRINTED NAME
TITLE
This form must be submitted in person to the Department of Motor Vehicles along with an application for a driver license or identification card in compliance with California Vehicle Code § 12811 (c)(5) and all requirements must be met prior to the issuance of a driver license or identification card with a veteran designation on the face of the card. In addition to any other fee, a $5 fee must be paid for the veteran designation.
SECTION 4 - |
DISABLED VETERAN CERTIFICATION FOR DISABLED VETERAN LICENSE PLATES |
|
|
TO BE COMPLETED BY AUTHORIZED COUNTY VETERANS SERVICE OFFICE EMPLOYEE, OFFICER, OR |
DESIGNEE |
The above named applicant is a disabled veteran who, as a result of injury or disease suffered while on active service with the armed forces of the United States, suffers from one or more of the following disabilities:
•Has a disability which has been rated at 100% by the United States Department of Veterans Affairs, due to a diagnosed disease or disorder which substantially impairs or interferes with mobility.
•Is so severely disabled as to be unable to move without the aid of an assistant device.
•Has lost, or has lost use of, one or more limbs.
•Has suffered permanent blindness, as defined in Section 19153 of the Welfare and Institutions Code.
SECTION 5 - TO BE COMPLETED BY AUTHORIZED COUNTY VETERANS SERVICE OFFICE EMPLOYEE, OFFICER, OR DESIGNEE
COUNTY VETERANS SERVICE OFFICE ADDRESS
CITY
STATE
ZIP CODE
PHONE NUMBER
COUNTY
EMAIL ADDRESS
As a representative of the County Veterans Service Office of the above named county, and designee of the California Department of Veterans Affairs, I certify under penalty of perjury under the laws of the State of California, that I have reviewed the documents
for the above named applicant that demonstrate that the applicant meets the qualifications noted above.
COUNTY VETERANS SERVICE OFFICE REPRESENTATIVE'S SIGNATURE
DATE
COUNTY VETERANS SERVICE OFFICE REPRESENTATIVE'S PRINTED NAME
TITLE
If this form is being submitted for an application for disabled veteran license plates only, this form and all other requirements, including acceptable proof of true full name and date of birth, may be submitted in person or by mail . For more information, please visit www.dmv.ca.gov.
FOR DMV USE ONLY
TECHNICIAN'S INITIALS/TECH ID #
DATELINE STAMP
APPLICANT'S DL/ID NUMBER
This form is not transferable |
Instructions on Utilizing Vsd 001
After gathering the necessary information, you are ready to fill out the VSD 001 form. This process involves providing personal details, certifying your veteran status, and ensuring that all information is accurate before submission. Follow these steps carefully to complete the form.
- Use blue or black ink to fill out the form.
- In Section 1, provide your first name, middle name, last name, and suffix.
- Enter your driver license or identification number along with the state of issuance.
- Fill in your date of birth in the format MM/DD/YYYY.
- Provide your email address and daytime telephone number.
- Complete your mailing address, including city, state, and ZIP code.
- If your residence address is different from your mailing address, fill in that information as well.
- In Section 2, read the certification statement carefully.
- Sign and date the form where indicated to certify your veteran status.
- Section 3 will be filled out by an authorized representative from the County Veterans Service Office.
- Ensure the representative provides their signature, date, printed name, and title in Section 3.
- If applying for disabled veteran license plates, the representative will complete Section 4.
- In Section 5, the representative will confirm that all documentation has been reviewed.
- Once completed, submit the form in person to the Department of Motor Vehicles along with your application for a driver license or identification card.
Make sure to pay the required $5 fee for the veteran designation. If you are applying for disabled veteran license plates only, this form can be submitted either in person or by mail. For additional details, visit the DMV website.
Misconceptions
The following list outlines common misconceptions regarding the VSD 001 form used in California for veteran status and service-connected disability verification.
- Misconception 1: The VSD 001 form can be submitted online.
- Misconception 2: Any discharge status qualifies for the veteran designation.
- Misconception 3: The $5 fee is the only cost associated with obtaining a veteran designation.
- Misconception 4: The form can be completed without any supporting documentation.
- Misconception 5: The form is only for veterans with 100% disability ratings.
- Misconception 6: The VSD 001 form is not legally binding.
- Misconception 7: The County Veterans Service Office has no role in the verification process.
- Misconception 8: Submitting the form guarantees immediate issuance of a veteran designation.
- Misconception 9: The form is transferable between individuals.
- Misconception 10: The form can be used for purposes other than obtaining a veteran designation on a driver license or ID card.
This form must be submitted in person to the Department of Motor Vehicles (DMV) along with an application for a driver license or identification card.
The applicant must have received an other than dishonorable discharge to qualify for the benefits associated with this form.
In addition to the $5 fee, applicants must meet all other requirements outlined by the DMV.
Applicants must provide necessary documentation to verify their service and discharge status.
The form is applicable to all veterans who meet the eligibility criteria, not just those with a 100% disability rating.
The applicant certifies under penalty of perjury that the information provided is true, making it a legally binding document.
The County Veterans Service Office is responsible for reviewing documentation and certifying eligibility for veteran status.
All requirements must be met, and the form must be processed by the DMV before the designation is issued.
The VSD 001 form is not transferable and is specific to the individual who completes it.
The form is specifically designed for the purpose of verifying veteran status and service-connected disabilities for DMV applications.
Documents used along the form
The VSD 001 form is essential for verifying veteran status and service-connected disabilities in California. When applying for benefits or licenses related to veteran status, several other forms may be required. Below is a list of documents commonly used alongside the VSD 001 form.
- Application for Disabled Veteran License Plates: This application is necessary for veterans seeking specialized license plates that indicate their disabled status. It requires proof of disability and may need to be submitted with the VSD 001 form.
- Non-Disclosure Agreement (NDA): To protect any confidential and proprietary information shared during the application process, it’s crucial to have a Non-Disclosure Agreement (NDA) in place. This legal document creates a confidential relationship between the parties involved. For more information on how to fill out this form, refer to All Washington Forms.
- California Driver License or Identification Card Application: This application must be completed when requesting a new or renewed driver license or ID card. It is submitted to the DMV along with the VSD 001 form to obtain a veteran designation.
- Verification of Military Service Form: This document confirms a veteran's service in the armed forces. It is often required to establish eligibility for various veteran benefits and may need to accompany the VSD 001 form.
- Disability Benefits Application: Veterans seeking financial assistance for service-related disabilities must complete this application. It typically requires detailed information about the veteran's health conditions and may be used in conjunction with the VSD 001 form.
- California Department of Veterans Affairs Benefits Application: This form is used to apply for a range of benefits available to veterans in California. It may need to be submitted alongside the VSD 001 form to ensure all relevant information is provided.
These documents play a crucial role in the process of obtaining veteran-related benefits and services. It is important to ensure that all necessary forms are completed accurately and submitted as required to facilitate a smooth application process.